uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Alternative names
Publications (10 of 16) Show all publications
Helgesson, G., Bertilsson, G., Domeij, H., Fahlström, G., Heintz, E., Hjern, A., . . . Hultcrantz, M. (2018). Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families. BMC Medical Ethics, 19, Article ID 1.
Open this publication in new window or tab >>Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families
Show others...
2018 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 1Article in journal (Refereed) Published
Abstract [en]

Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.

Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.

Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Alcohol consumption, Alcohol exposition, ARBD, ARND, Diagnostics, Ethics, Family support, Fas, FASD, pFAS
National Category
Medical Ethics
Identifiers
urn:nbn:se:uu:diva-341581 (URN)10.1186/S12910-017-0242-5 (DOI)000419520800001 ()29304784 (PubMedID)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2014-4024
Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-02-14Bibliographically approved
Helgesson, G., Bertilsson, G., Domeij, H., Fahlstrom, G., Heintz, E., Hjern, A., . . . Hultcrantz, M. (2018). Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families. BMC Medical Ethics, 19, Article ID 1.
Open this publication in new window or tab >>Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families
Show others...
2018 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 1Article in journal (Refereed) Published
Abstract [en]

Background:

Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.

Methods:

Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.

Results:

Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition.

Conclusions:

The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

Keywords
Alcohol consumption, Alcohol exposition, ARBD, ARND, Diagnostics, Ethics, Family support, Fas, FASD, pFAS
National Category
Psychiatry Medical Ethics
Identifiers
urn:nbn:se:uu:diva-341491 (URN)10.1186/S12910-017-0242-5 (DOI)000419520800001 ()29304784 (PubMedID)
Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-02-21Bibliographically approved
Domeij, H., Fahlstrom, G., Bertilsson, G., Hultcrantz, M., Munthe-Kaas, H., Nehlin Gordh, C. & Helgesson, G. (2018). Experiences of living with fetal alcohol spectrum disorders: a systematic review and synthesis of qualitative data. Developmental Medicine & Child Neurology, 60(8), 741-+
Open this publication in new window or tab >>Experiences of living with fetal alcohol spectrum disorders: a systematic review and synthesis of qualitative data
Show others...
2018 (English)In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no 8, p. 741-+Article, review/survey (Refereed) Published
Abstract [en]

Aim: To identify and assess available evidence from qualitative studies exploring experiences of individuals living with fetal alcohol spectrum disorders (FASD) or those living with a child with FASD, as well as experiences of interventions aimed at supporting individuals with FASD and their families.

Method: A systematic literature search was conducted in six electronic databases: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Scopus. Included studies were analysed using manifest content analysis. Methodological limitations and confidence in the evidence were assessed using a modified version of the Critical Appraisal Skills Programme and the Grading of Recommendations, Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach respectively.

Results: Findings from 18 studies show that individuals with FASD experience a variation of disabilities, ranging from somatic problems, high pain tolerance, destructive behaviour, hyperactivity, and aggressiveness, to social problems with friendship, school attendance, and maintenance of steady employment. Most studies reported parents’ experiences with FASD; parenting was viewed as a lifelong engagement and that the whole family is isolated and burdened because of FASD. People with FASD feel that their difficulties affect their daily life in a limiting way and make them feel different from others.

Interpretation: From the perspective of primarily parents, individuals with FASD and their parents face many different difficulties, for which they need societal support.

National Category
Medical Ethics
Identifiers
urn:nbn:se:uu:diva-365260 (URN)10.1111/dmcn.13696 (DOI)000437733500011 ()29479676 (PubMedID)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2014-4024
Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-12Bibliographically approved
Nehlin, C., Wennberg, M. & Öster, C. (2018). How do people with mood and anxiety disorders perceive and interpret the Drinking Motives Questionnaire?: A think-aloud study in a clinical setting. Addiction science & clinical practice, 13, Article ID 7.
Open this publication in new window or tab >>How do people with mood and anxiety disorders perceive and interpret the Drinking Motives Questionnaire?: A think-aloud study in a clinical setting
2018 (English)In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 13, article id 7Article in journal (Refereed) Published
Abstract [en]

Background: Research has identified drinking motives as the final common pathway to alcohol use, and associations between specific drinking motives and drinking patterns have consistently been demonstrated. Data on drinking motives can be used for research, in the planning of prevention strategies and for treatment purposes. The Drinking Motives Questionnaire-Revised (DMQ-R) has become the most used measure of drinking motives. So far, the questionnaire has not been investigated with qualitative methods. The aim of this study was to investigate acceptability, accuracy and usability of the DMQ-R among persons receiving outpatient psychiatric care by studying how responders perceive and interpret the questionnaire.

Method: A cognitive interviewing technique, the think-aloud method, was used to collect data from 16 non-alcohol dependent patients seeking outpatient psychiatric care (12 women, 4 men). To analyse data, Qualitative Content Analysis was applied in which themes were formed from data only and not from predetermined areas of interest.

Results: Overall, acceptability of the DMQ-R was high although answers were sometimes given with low accuracy. Responders pointed out that they perceived the questionnaire as non-confrontational and exhaustive. Further, the DMQ-R seemed to launch processes of self-reflection.

Conclusions: Taken together, the results suggest a support for the use of DMQ-R also in the group of psychiatric outpatients. Still, when interpreting the DMQ-R, a certain insecurity of the exactness of answers should be considered. The graphic design should be particularly clear in this group of patients.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Questionnaires, Drinking motives, DMQ-R, Think-aloud method, Psychiatric care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-351435 (URN)10.1186/s13722-018-0109-1 (DOI)000427779900001 ()29534735 (PubMedID)
Available from: 2018-06-01 Created: 2018-06-01 Last updated: 2018-06-01Bibliographically approved
Nehlin, C., Carlsson, K. & Öster, C. (2018). Patients' Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes. Journal of addiction medicine, 12(2), 107-112
Open this publication in new window or tab >>Patients' Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes
2018 (English)In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 12, no 2, p. 107-112Article in journal (Refereed) Published
Abstract [en]

Objectives: The field of eHealth systems is rapidly developing and is now expanding into alcohol treatment settings. Despite a growing public and professional interest, cellular photo digital breathalyzers (CPDBs) have not been investigated in a clinical context so far. In this study, we aimed to investigate the experiences of patients in alcohol treatment who had been using a CPDB—TripleA- for a minimum of three months. What are their personal experiences of using the CPDB? Do the patients think it supports them to change their drinking habits, and if so, in what way?

Methods: A qualitative interview study with individuals who had been using the CPDB TripleA, for at least 3 months as complement to treatment (12-step program or hospital-based outpatient care). A thematic analysis with an inductive approach was used to identify, analyze, and interpret patterns within data.

Results: In all, 12 interviews were conducted with 8 men and 4 women. Participants were generally enthusiastic about the CPDB and found it convenient and useful, even though it created a need for privacy when using the device. Although technical problems were substantial, participants were tolerant to those. The system was perceived to support self-control and to restore relations, but did not replace the need for close contact with caregivers. Self-motivation to change drinking habits was essential, and could not be reached by solely using the CPDB.

Conclusions: Participants perceived the CPDB as a convenient and useful tool that was supportive under the circumstances that it was used in a context that included personal contact with a caregiver; and the user felt more than just a minimum of motivation to reduce drinking. Technical stability needs to be achieved to secure long-term use.

Keywords
alcohol treatment, cellular photo digital breathalyzers, motivation, patients' experiences, qualitative, remote BAC monitoring
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-351090 (URN)10.1097/ADM.0000000000000373 (DOI)000427987500004 ()29176448 (PubMedID)
Funder
VINNOVA
Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2018-05-18Bibliographically approved
Nehlin, C., Arinell, H., Dyster-Aas, J. & Jess, K. (2017). Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders. Journal of dual diagnosis, 13(4), 247-253
Open this publication in new window or tab >>Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders
2017 (English)In: Journal of dual diagnosis, ISSN 1530-3209, E-ISSN 1550-4271, Vol. 13, no 4, p. 247-253Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits.

METHODS: From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared.

RESULTS: Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems.

CONCLUSIONS: Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.

Keywords
Drinking habits, health care use, psychiatric treatment
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-330153 (URN)10.1080/15504263.2017.1347307 (DOI)000423373400003 ()28665254 (PubMedID)
Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-03-12Bibliographically approved
Hammarberg, A., Öster, C. & Nehlin, C. (2017). Drinking motives of adult patients seeking treatment for problematic alcohol use. Journal of Addictive Diseases, 36(2), 127-135
Open this publication in new window or tab >>Drinking motives of adult patients seeking treatment for problematic alcohol use
2017 (English)In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 36, no 2, p. 127-135Article in journal (Refereed) Published
Abstract [en]

The Drinking Motives Questionnaire measures motives for alcohol consumption on four subscales. Coping with negative affect and enhancement of positive affect have been shown to be associated with high levels of alcohol consumption and alcohol-related problems. Few studies exist concerning drinking motives among treatment-seeking patients. The aims of the study were to investigate the factor structure of the shortened-form of the revised Drinking Motives Questionnaire, map main drinking motives, explore group differences in motives due to sex, age, level of drinking problems, and symptoms of depression/anxiety and to investigate whether different drinking motives predict alcohol-related problems in this group. There were 274 treatment-seeking patients recruited from four addiction treatment clinics in Sweden. The shortened-form of the revised Drinking Motives Questionnaire was administered in conjunction with a regular visit to the clinics together with measures of degree of alcohol-related problems, psychiatric symptoms, and demographic factors. Main drinking motives were identified. A confirmatory factor analysis was run to confirm the factor structure of the shortened-form of the revised Drinking Motives Questionnaire. A logistic regression using the Enter method was performed to investigate associations between predictors and Alcohol Use Disorder Identification Test scores. The results confirmed the four-factor structure reported in studies on non-treatment-seeking individuals. Coping was the most commonly expressed motive. Not previously found in a clinical sample, the results showed that coping motives, together with being male and having elevated anxiety scores, were associated to Alcohol Use Disorder Identification Test scores indicative of alcohol dependence. The shortened-form of the revised Drinking Motives Questionnaire is a brief and valid instrument that holds potential for clinical use in mapping drinking motives among treatment seekers.

Keywords
DMQ-R-SF, Motives for drinking, alcohol dependence, coping, treatment seekers
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-321377 (URN)10.1080/10550887.2017.1291052 (DOI)000399659500005 ()28166486 (PubMedID)
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2017-05-19Bibliographically approved
Öster, C., Arinell, H. & Nehlin, C. (2017). The Drinking Motives Questionnaire among Swedish psychiatric patients: An exploration of the four-factor structure. Drug and Alcohol Review, 36(3), 400-407
Open this publication in new window or tab >>The Drinking Motives Questionnaire among Swedish psychiatric patients: An exploration of the four-factor structure
2017 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 36, no 3, p. 400-407Article in journal (Refereed) Published
Abstract [en]

Introduction and Aims: Alcohol use above hazardous limits is common among persons with psychiatric disorders, and there is limited knowledge about motives for drinking. The objective of this study was to explore the adequacy of the four-factor structure of drinking motives in an adult psychiatric outpatient population in Sweden by confirming the factor structure in the Drinking Motives Questionnaire (DMQ-R) and in alternative models.

Design and Methods: In total, 371 patients responded to the DMQ-R along with the Alcohol Use Disorders Identification Test (AUDIT). AUDIT was used to assess frequency of alcohol consumption, number of drinks consumed on a typical occasion and binge drinking frequency. Confirmatory factor analysis was used to examine the construct validity of the DMQ-R and alternative models, including the short form, DMQ-R SF.

Results: Fit statistics suggested that the original four-factor model had questionable fit (root mean square error of approximation [RMSEA]=0.10, comparative fit index [CFI]=0.89, standardised root mean square residual [SRMR]=0.08). The model with the best fit indices was the DMQ-R SF (RMSEA=0.07, CFI=0.97, SRMR=0.04). When using DMQ-R SF in further analyses enhancement, the most strongly endorsed motives were related to quantity and AUDIT sum score. Coping motives were most strongly related to AUDIT sum score, frequency and binge drinking. Social motives were only related to binge drinking, whereas conformity motives were not statistically associated with any motives.

Discussion and Conclusions: The study implies that the 12-item short form, DMQ-R SF, could be more appropriate than the original DMQ-R in this group.

National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-310964 (URN)10.1111/dar.12421 (DOI)000401238500015 ()27288296 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2017-06-22Bibliographically approved
Nehlin, C., Nyberg, F. & Jess, K. (2016). Brief Intervention Within Primary Care for At-Risk Gambling: A Pilot Study. Journal of Gambling Studies, 32(4), 1327-1335
Open this publication in new window or tab >>Brief Intervention Within Primary Care for At-Risk Gambling: A Pilot Study
2016 (English)In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, no 4, p. 1327-1335Article in journal (Refereed) Published
Abstract [en]

Studies on interventions for at-risk gambling are scarce. This pilot study is the first step in a larger project aimed to develop methods to prevent more serious gambling problems. Drawing on experiences from the alcohol field, the brief intervention (BI) model was tested in a primary care setting. Primary care personnel was trained for 2 days. Patients were screened, and those with signs of problematic gambling were offered a return visit to discuss their gambling habits. Of the 537 screened, 34 (6.3 %) screened positive for problem gambling. Of those, 24 were at-risk gamblers whereof 19 agreed to participate. Six of those 19 took part in a 1-month follow-up. Important information for the planning of upcoming studies was collected from the pilot work. Given that the rate of at-risk gamblers was elevated in this setting we consider primary care a suitable arena for intervention. Staff training and support appeared essential, and questionnaires should be selected that are clear and well-presented so staff feel secure and comfortable with them. The BI model was found to be most suitable for patients already known to the caregiver. The number of participants who were willing to take part in the follow-up was low. To ensure power in future studies, a much larger number of screened patients is evidently necessary.

Keywords
Brief intervention (BI), At-risk gambling, Primary care, Pilot study
National Category
Psychiatry Substance Abuse
Identifiers
urn:nbn:se:uu:diva-310738 (URN)10.1007/s10899-016-9610-1 (DOI)000387615100018 ()27038815 (PubMedID)
Funder
Public Health Agency of Sweden
Available from: 2016-12-20 Created: 2016-12-19 Last updated: 2017-11-29Bibliographically approved
Nehlin Gordh, C., Nyberg, F. & Öster, C. (2015). The patient´s perspective on the link between ADHD and substance use: A qualitative interview study. Journal of Attention Disorders, 19(4), 343-350
Open this publication in new window or tab >>The patient´s perspective on the link between ADHD and substance use: A qualitative interview study
2015 (English)In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 19, no 4, p. 343-350Article in journal (Refereed) Published
Abstract [en]

Object

The primary aim of this study was to investigate how adult individuals with ADHD perceive the role of alcohol and drugs in their lives. A secondary aim was to identify factors that those individuals consider useful in the treatment and prevention of co-occurring ADHD and substance use disorders.

Method

A qualitative interview study with ADHD outpatients (n=14) at a psychiatric clinic. Data were analyzed based on pre-defined areas of interest using a deductive content analysis method.

Results

The yearning for belongingness was identified as an important driving force underlying substance use. The participants felt that alcohol/drugs helped them being normal and thus respected and accepted. Early diagnosis of ADHD was perceived essential to avoid SUD.

Conclusion

Adults with ADHD may have strong rational and emotional reasons for the use of alcohol and drugs. When planning for the treatment of adult ADHD, investigation of personal reasons for alcohol/drug use deserves a place.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keywords
Adult ADHD, substance abuse, reasons for co-occurrence, qualitative
National Category
Pharmaceutical Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-235444 (URN)10.1177/1087054714554618 (DOI)000350975100008 ()25359762 (PubMedID)
Available from: 2014-11-03 Created: 2014-11-03 Last updated: 2018-01-11Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9404-5183

Search in DiVA

Show all publications